West Africa Ebola Outbreak Update

2014-10-03

West Africa Ebola outbreak

Since March 2014, West Africa has been in the grip of an unprecedented outbreak of Ebola haemorrhagic fever which has infected more than 4,000 people, including 2,218 deaths. Defined as the deadliest and most widespread Ebola outbreak to ever be recorded, the presence of the disease has been recorded in the West African countries of Guinea, Sierra Leone, Liberia, Nigeria and, most recently, in Senegal. An outbreak of has also been confirmed in the Boende district of the Democratic Republic of Congo (DRC)’s northern Equateur province; however, epidemiological investigation conducted by the World Health Organization (WHO) confirmed that the outbreak in Boende was distinct from the strain of Ebola currently affecting the West Africa region.

In terms of the West Africa Ebola outbreak, the WHO has attributed the ongoing increase of deaths and infections to traditional and cultural practices, particularly relating to burial practices, as well as to the prevalence of the disease in densely populated low-income districts in major cities. These include the respective capitals of Guinea (Conakry), Sierra Leone (Freetown) and Liberia (Monrovia), where access to adequate sanitation and health care is limited. Social and economic activities occurring across the borders of these countries have also been labelled by the WHO as contributing to the spread of the disease. The outbreak is also not expected to be eradicated within the short-term. On 3 July, the UN further confirmed that, at the very minimum, the Ebola outbreak was anticipated to last for several months and likely to infect at least 20,000 people before its forecasted containment.

Affected countries

Guinea

The West Africa Ebola outbreak was first reported in the south eastern Macenta, Gueckedou and Kissidougou prefectures, where the disease was initially mistaken for Lassa fever. Subsequent cases have also been confirmed in the Dabola, Djingaraye, Telimele, Boffa, Kouroussa, Dubreka, Fria, Siguiri and Pita administrative divisions. The presence of the disease has also been reported in the densely populated capital, Conakry. In total, 861 cases have been reported in the country, including an estimated 557 fatalities.

Sierra Leone

In Sierra Leone, the presence of Ebola has been detected in the country's Kailahun, Kenema, Kambia, Port Loko, and Bo districts. More recently, the Tonkolili, Bambali, Moyamba, Bonthe, and Pujehun districts have also registered confirmed cases. Reports of Ebola infections and deaths have also been reported in the capital, Freetown, in addition to the wider Western Area administrative division. To date, Ebola has infected 1,424 people and resulted in 524 deaths in the country.

Liberia

In Liberia, both suspected and confirmed cases of Ebola have been reported in the Lofa, Montserrado, Margibi, Bomi, Bong, Nimba, Rivercess, Grand Cape Mount and Grand Bassa counties. Testing for the disease is also currently being conducted in the capital, Monrovia. In total, 2,081 cases of Ebola, including 1,137 deaths, have been reported across the country.

Nigeria

In Nigeria, at least eight fatalities and 19 cases of Ebola are being investigated by the Nigerian Health Ministry and the WHO. According to a communique released by the WHO on 19 August, all but three of the confirmed cases in Nigeria have been reported in the city of Lagos and formed part of a single chain of transmission. The other three cases of the disease, including at least one fatality, have been confirmed in the city of Port Harcourt, the administrative capital of the southern Rivers State. Although asserting that they have contained the Ebola outbreak in Lagos, Nigerian health authorities are monitoring more than 200 people in connection with the latest outbreak in Port Harcourt. Of these, as many as 60 people are considered to have had a high risk of exposure.

Senegal

On 30 August, Senegal's health ministry confirmed that a case of Ebola has been detected in the capital, Dakar. The individual symptomatic for the disease was a Guinean national who had travelled to the city via road from Guinea's capital, Conakry. Two additional Ebola infections have since been reported in Dakar, both of which are believed to be linked to the initial infection. The WHO has since deployed initial health care workers to the Senegalese capital and is tracing persons that the victim may have come into contact with during his stay in Senegal.

Democratic Republic of Congo

On 21 August 2014, health authorities in the DRC claimed that an unknown form of haemorrhagic fever had killed at least 13 people over a period of 10 days in the country’s north western Equateur province. The outbreak of the disease was limited to the town of Boende. On the 2 September, results from the virus sequencing samples analysed at the WHO corroboration centre at Gabons Centre International de Recherches Medicales in Franceville confirmed that the disease was a form of Ebola haemorrhagic fever. According to the WHO, results from the virus characterisation, along with findings from the epidemiological investigation, confirmed that the Ebola outbreak in Boende was distinct and in no way related to the strain of Ebola currently affecting the West Africa region. As of 15 September, at least 53 cases, including 31 deaths, of Ebola haemorrhagic fever have been identified. No confirmed or suspected cases have been reported outside of Boende at this stage.

Regional and international response to the outbreak

In response to the Ebola outbreak, a number of movement-restrictive measures and travel advisories have been issued by various governments and international health bodies.

Border closures

The governments of Guinea, Liberia and Sierra Leone have all closed their shared borders as a means of stemming the spread of the outbreak. Cote d'Ivoire has also closed its shared borders with Liberia and Guinea, while Senegal has closed all points of entry (land, border and sea) to persons originating from Guinea, Liberia and Sierra Leone. Chad and Cameroon have also closed sections of their shared borders with Nigeria. The duration of the aforementioned restrictions to cross-border travel remains unclear at this stage.

Commercial Air Travel Restrictions

Air France: All flights to Sierra Leone have been suspended indefinitely.

Arik Air: All flights to Liberia and Sierra Leone have been suspended indefinitely.

ASKY Airlines: All flights to Guinea, Liberia and Sierra Leone have been suspended indefinitely.

British Airways: All flights to Liberia and Sierra Leone have been suspended until 21 December 2014.

Ceiba Intercontinental: All West African flight schedules have been suspended indefinitely.

Emirates: All flights to Guinea have been suspended indefinitely.

Senegal Airlines: All flights to Guinea have been suspended indefinitely.

Entry and/or visa restrictions

A number of foreign governments have also imposed entry and/or visa restrictions to persons travelling from or who have transited through Ebola-affected countries.

Botswana: Entry has been denied to all travellers from the countries of Guinea, Nigeria and Sierra Leone, subject to period of travel.

Cape Verde: Entry has been denied to all travellers from the countries of Guinea, Liberia, Nigeria, Sierra Leone and Senegal, subject to period of travel.

Chad: Entry has been denied to all non-citizens travelling from the countries of Guinea, Liberia, Nigeria and Sierra Leone.

Gabon: Allocation of entry visas will be restricted to travellers originating from or who have transited through the countries of Guinea, Liberia, Sierra Leone and Nigeria.

Kenya: Entry has been denied to all travellers from the countries of Guinea, Liberia and Sierra Leone, subject to period of travel.

Namibia: Entry has been denied to all non-citizens travelling from the Ebola-affected countries.

Rwanda: Entry has been denied to all travellers from the countries of Guinea, Nigeria and Sierra Leone, subject to period of travel.

South Africa: Entry has been denied to all non-citizens travelling from the countries of Guinea, Liberia and Sierra Leone.

Official health advisories

On 31 July, the US Centres for Disease Control (CDC) issued a Level 3 warning, effectively advising US nationals to avoid all non-essential travel to the West African countries of Guinea, Liberia and Sierra Leone. In addition to this, the health body further advised West African customs and immigration authorities to prevent persons exhibiting symptoms of the disease from boarding both international and domestic flights. The CDC also asserted that measures were being implemented, including quarantine centres, for persons arriving at US points of entry who were suspected of being infected with Ebola.

On 8 August, the WHO also declared the Ebola outbreak as a Public Health Emergency of International Concern (PHEIC). It cited that the outbreak was of an unprecedented nature and that it constituted a concern to global health. However, despite the advisory, the WHO has not issued any trade or travel restrictions for any country which has detected, confirmed and/or suspected Ebola infections. It has further asserted that the risk to foreign travellers, including those travelling to and/or visiting affected areas, remains low at this time, provided such individuals are not involved in any activities that would place them in direct contact with infected persons. The risk is further mitigated by employing strict hygiene protocols, limiting contact with persons exhibiting symptoms of the disease, and avoiding locations such as hospitals, marketplaces and other crowded public venues, where the risk of transmission is increased. A full WHO statement on travel and transport regulations in light of the Ebola outbreak can be accessed by clicking here.

Disease information and AAI’s advice

What is Ebola?

Ebola haemorrhagic fever is a close relative of the Marburg virus; both stem from the Filoviriade virus family. There are four identified subtypes of the virus that affect humans: Ebola-Zaire, Ebola-Sudan, Ebola-Ivory Coast and Ebola-Bundibugyo. It is one of the most virulent viral diseases and causes death in 50 to 90 percent of all clinical cases. The disease is rife in parts of Central and West Africa, with confirmed cases having been reported in the DRC, Gabon, Sudan, Cote d'Ivoire, Uganda and the Republic of Congo. Most recently, cases have been reported in Guinea, Liberia, Sierra Leone and Nigeria.

How is the Ebola virus transmitted?

Ebola is an acute infection, with no carrier state. The virus is contracted through direct contact with the blood or other bodily secretions of an infected person or through handling contaminated objects. Humans are also at risk of contracting the virus if they come into contact with infected animals.

Signs and symptoms

The incubation period for Ebola ranges from 2 to 21 days. The onset of illness is abrupt, with sufferers experiencing fever, intense fatigue, headaches and muscle aches. These symptoms are followed by diarrhoea, vomiting, stomach pain, chest pain and shock. In some infected patients, a rash, red eyes, hiccups and internal and external bleeding may occur. If untreated, the disease is often fatal.

AA International's Advice

In general, foreign nationals are at a low risk of contracting Ebola, provided that they are not involved in any activities which would place them in direct contact with infected persons. Nonetheless, the current movement-restrictive measures implemented as a means of stemming disease may compromise the ability of foreign travellers to depart Ebola-affected countries in the event of an emergency. Consequently, AA advises against all non-essential travel to the Ebola-affected countries of Guinea, Sierra Leone and Liberia. Furthermore, persons currently in the aforementioned countries in a non-essential capacity are advised to consider departing via commercial means where safe and possible to do so. Due to the limited nature of the outbreak in Nigeria and Senegal, AA currently has no specific Ebola-related travel advisories for these countries.

Persons currently in or intending to travel to the Ebola-affected countries despite this advisory should make allowances for travel delays at points of entry due to health screening. Individuals exhibiting any of the typical Ebola symptoms mentioned above are strongly advised to avoid conducting any form of travel, particularly via commercial air travel, as doing so may result in a sufferer being quarantined at a facility where the disease is being treated. This could heighten an individual's risk of exposure to the virus. If infection is suspected, it is advisable to proceed to a high-quality health care facility immediately. Patients are normally isolated and local and national health departments notified. There is no standard treatment for the virus; care is primarily supportive and includes maintaining fluid balance, correcting electrolyte abnormalities, oxygenation and haemodynamic support. For further information on the current outbreak affecting parts of West Africa, please consult the WHO's Ebola fact sheet and/or the WHO's West Africa Ebola Outbreak information page.

About AA International

AA International is Asia’s leading provider of local and international medical & security assistance, automobile and outsourced contact centre industry.

AA International was recently involved in an evacuation from Liberia. The evacuation was initiated due to the devastating outbreak of the Ebola Virus, which has to date claimed over 2,000 lives and Liberia has been worst hit. AAI offers a service to eliminate risk for travellers and expatriates to the highest level and it was deemed that the risk was too high for the expatriates in country to remain in Liberia. Continual crisis management support is being provided to the clients, so that they are able to provide duty of care to the remaining local staff and also to the repatriated staff in the form of advice to ensure social responsibility by self-quarantining and the provision of daily medical checks to check for any possible signs of the deadly virus.

AA International has composed some information to provide an update on the West Africa Ebola Outbreak and advice, please see below: for more information or advice please do not hesitate to contact us at enquires.globalsecure@aa-international.com

About GlobalHealth Asia

Headquartered in Hong Kong, GlobalHealth Asia serves individuals, families and companies of all sizes across Asia and around the world. GlobalHealth believes that international benefits provided with a local presence in Asia ensures the best mix of cover and service. With offices in Hong Kong, Shanghai, Ho Chi Minh and Singapore, GlobalHealth has built a reputation for providing excellent cover at affordable premiums.